Impotence is the inability of a person to perform sexual intercourse. Sterility is the inability of the male to beget children, and in the female the inability to conceive children. About 10 to 15% of all married couples are involuntarily sterile.
A person can be sterile without being impotent, or he can be impotent without being sterile, or both may co-exist. Frigidity is the inability to initiate or maintain the sexual arousal pattern in the female. Ejaculation which occurs immediately before or immediately after penetration is termed premature ejaculation. Sexual dysfunction is impairment either in the desire for sexual gratification or in the ability to achieve it.
The question of impotence and sterility may arise in:
(A) Civil :
(1) Nullity of marriage,
(2) Divorce,
(3) Adultery,
(4) Disputed paternity, and legitimacy,
(5) Suits of adoption, and
(6) Claim for damages where loss of the sexual function is claimed as the result of an assault or accident.
(B) Criminal :
(1) Adultery,
(2) Rape, and
(3) Unnatural offences, where impotency is pleaded as a defense.
Possible Causes:
(1) Age :
The power of erection and therefore of coitus, may be present at a much earlier age than puberty. Poor physical development of the penis is a common cause of impotence, and therefore the medical examiner should depend more' on the development of the private parts of the person than on his age.
In cases of precocious development, as in gonadal or adrenal tumors, Mc-Cune Albright Syndrome, the sexual organs may show advance development as compared to the body as a whole. In advanced age, the power of erection and the ability to perform the coitus may diminish or disappear, but there is no specific age at which such loss of power occurs. Spermatozoa are not usually found before the age of puberty, but may be found in the semen of men of advanced age. As long as live spermatozoa are present-in the seminal fluid, the individual must be presumed to be fertile. Boys of nine years and old people of 94 having children have been recorded.
(2) Defects of Development and Acquired Abnormalities :
Absence of penis excludes coitus and non-development of penis may prevent the sexual act. In case of partial amputation, sexual act may not be possible. Certain malformations of external genitals, e.g., intersexuality, hypospadiasis and epispadiasis may prevent intercourse, and even when intercourse is possible, the seminal fluid may not reach the vagina, because of the abnormal position of the urethral orifice, but such individuals are not necessarily sterile. Double penis and the penis adherent to the scrotum may cause difficulty in sexual intercourse. Losses of both testicles cause complete sterility after, a certain time, but may not produce impotence. If the testes are removed before puberty impotence is the rule, but if the testes are removed after puberty, potency is retained. The removal of one testis does not affect either potency or fertility. Cryptorchids are not necessarily either sterile or impotent, but sterility is common. With both testes present a man may be sterile due to azoospermia.
(3) Local Diseases :
Temporary impotency may be caused by acute disease of the penis, such as gonorrhea, sores on the glans, etc. Large hernias, elephantiasis or large hydroceles, phimosis, paraphimosis and adherent prepuce may cause temporary impotence by mechanical obstruction to sexual intercourse. Diseases of the testicles,- epididymis or penis, such as cancer, sarcoma, tuberculosis, syphilis, trauma, etc., may cause sterility, impotence or both.
Fracture pelvis with injury to parasympathetic, fracture spine at L-l level with injury to sacral segments of spinal cord can result in impotence. Lithotomy operation may damage ejaculatory ducts and produce sterility. Exposure to X-rays causes temporary azoosperraia. When spermatic cords are blocked due to operation or disease, ligated or cut, sterility
results.
(4) General Diseases :
Impotence is common during the course of any acute illness; . in convalescence, normal function is rapidly regained. General diseases causing anemia and debility, e.g., diabetes, pulmonary tuberculosis, chronic nephritis, etc., may cause temporary impotence. General ill- health may be associated with diminished fertility.
Endocrine disease may produce sexual infantilism and impotence. Certain conditions of the central nervous system, such as hemiplegia, paraplegia, locomotor ataxia, disseminated sclerosis, syritigomyelia and fracture of vertebrae with cord injury may cause impotence, but this is not always so. Lack of sexual power is common in those suffering from paranoia, tabes dorsalis and general paralysis of the insane. Occasionally, the reverse effect, i.e. satyriasis or excessive sexual inclination is seen. Tumors or injury of cauda equina, and spina bifida produce impotence.
Impotence may also be produced by excessive masturbation and the excessive and continued use of some drugs, e.g. alcohol, opium, cannabis indica, tobacco, cocaine and bromides while the habit lasts. Impotence and failure to ejaculate may occur due to excessive tranquillizations. Temporary impotence is found in neurasthenia. Occupational exposure to lead may lead to sterility. Orchitis following mumps especially in adolescence may cause atrophy of the testes and may occasionally lead to sterility rather than impotence.
(5) Psychical Causes :
Emotional disturbances are a common cause of temporary impotence. Fear of impotence or fear or inability to complete the act is common cause of temporary impotence but usually they are soon overcome. Disgust of the sexual act or dislike of the partner may cause temporary or permanent impotence.
Anxiety, guilt sense, timidity, depression, excessive passion and sexual overindulgence produce temporary impotence.
Quoad is an individual who may be impotent with one particular woman (quoad=as regards) but not with others. Psychological-causes of impotence greatly outnumber all other causes.
|
| 149 : vote(s) so far
| Cast your vote: